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Background and Aims Phantom limb pain, affecting up to 80% of amputation patients, results from a complex interplay of factors including severe pain experiences, peripheral and central sensitization and altered body perception. The surgical removal of a limb disrupts afferent feedback and causes neuroplastic changes in the sensorimotor cortex. Effective management requires a multimodal approach and pain control is fundamental for an effective rehabilitation pathway.

Methods A 26-year-old male, had a right upper limb traumatic amputation from a work accident the previous year. An active smoker but otherwise healthy, he is followed in a chronic pain clinic for phantom limb pain and is a candidate for a bionic prosthesis. Initially on pregabalin 150mg, he rated his pain as intense, with various neuropathic pain symptoms in the amputated limb, including tingling and ice-cold sensation. Examination revealed allodynia in the scar area.

Results His medication was increased to pregabalin 450mg and amitriptyline 10mg, with tramadol plus paracetamol as needed. Two months later, after starting prosthesis training, pain worsened and the idea of moving the lost arm was excruciating. An ultrasound-guided supraclavicular brachial plexus block was performed with 20mL of ropivacaine 0.2% and 4mg dexamethasone. His usual medication was maintained. At revaluation, he reported controlled phantom limb pain during physiotherapy, allowing an effective prosthetic training.

Conclusions Proactive, multimodal management of phantom limb pain by an interdisciplinary team is essential to prevent long-term complications, improve rehabilitation, promote independence and quality of life.